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Health Disparities Among Children with Asthma in the United States by Place of Residence
No full textBackground: Children residing in poor-urban areas may have greater asthma morbidity. It is unclear whether this is due to individual characteristics such as race and ethnicity or place of residence. Objective: Assess indicators of control and treatment by residence. Methods: This was a cross-sectional analysis of children (aged 1-17 years) in the 2000-2014 Medical Expenditure Panel Survey (MEPS). Indicators of poor control included use of more than 3 canisters of short-acting beta agonist (SABA) in 3 months, asthma attack, and emergency department (ED) or inpatient (IP) visit during the year. Treatment measures included use of controller medications and a ratio of controller-to-total prescriptions of 0.7 or more. Results: There were 15,052 children with asthma in the MEPS 2000-2014 data, reflecting 8.4 million children in 2014. After controlling for covariates, children with asthma residing in poor-urban areas had lower odds of using controller medications (odds ratio [OR] = 0.77), having a controller-to-total ratio of 0.7 or more (OR = 0.75), and reporting an asthma attack (OR = 0.75) and higher odds of having an ED/IP visit (OR = 1.3) compared with those living elsewhere. Black race and Hispanic ethnicity were associated with greater odds of excessive SABA use (OR = 2.11) and ED/IP visits (OR = 2.03) and lower odds of controller-to-total ratio of 0.07 or more (OR = 0.50). Conclusions: Poor-urban residence may be independently associated with asthma control and treatment even after controlling for individual characteristics such as race and ethnicity. Future research is needed to understand the sources of these geographic health disparities to more successfully target public health interventions
HOUSE AND FAMILY
Get PDFThe intention of this research is to establish the idea of a standard Four Person grouping in literature. In many modern stories, the ensemble holds a special place in people’s hearts, especially if they identify specifically with a certain member of the ensemble. This allows friend groups to debate placement and discuss their roles, all while appealing to our sublimated desperation to belong and to be represented. This paper will examine perhaps the most ubiquitous separation of fictional characters into four groups, the sorting of the Hogwarts Houses in Harry Potter. This thesis posits that sorting is based on determinable and reproducible factors, and that these factors are universal throughout groupings in Western literature. The thesis will first posit a sorting system to divide the Houses that is specific and upheld by the literature, the actions of the characters in each House, and the words of the author outside of the literature and second, the thesis will then attempt to ‘sort’ a collection of four other characters from Shakespeare’s King Lear. It will analyze the characters from the perspective of their motivations, their actions, and their words, and see if they fall naturally into the same divisions as the Hogwarts Houses. This will be a test case for the theory that literary groupings of four will naturally arrange themselves into these groupings. Finally, the thesis will examine the implications of the sorting system, its veracity, and if it works to sort the characters of both the books and the test case
Under the Stained-Glass Ceiling: The Ambiguous Position of Ordained Women in Protestant America
Get PDFThe ordination and pastorship of women in Protestant America is as ambiguous as it is rare. Due to the constitutional separation of church and state in the U.S, churches do not follow anti-discrimination laws, and can hire or reject women for employment at their own discretion. This thesis argues that this discretion has created a disconnect between the acceptance of female pastors that many Protestant denominations of Christianity advertise, compared to what actually comes to fruition for women who are ordained within these denominations. This thesis will ultimately present the adverse reality of being an ordained Protestant woman in America by synthesizing different theological perspectives, remarking on America’s sexually objectifying culture, dissecting three statistical analyses about female pastors in the U.S, and reporting on interviews the author conducted with female pastors. The author concludes this thesis by explaining why this reality impacts all Americans and proposes possible solutions to ameliorate the hardships ordained Protestant women face daily
The Future of Biomath: Growing Beyond Collaboration
Get PDFBiomathematics as a field has grown substantially over the last 50 years. It has found success in modeling biological phenomena in a variety of areas ranging from ecology to molecular biology [Mackey and Maini, 2015]. Furthermore, the continued development of biomath may be invaluable in understanding current challenges in biology, such as predicting the effects of climate change on different ecosystems. All successful interdisciplinary research depends different types of scientists having the ability to understand and collaborate well with each other. Traditionally, mathematicians are exclusively trained in theoretical systems, while biologists usually work in experimentally driven laboratory settings. As a result, collaboration can lead to miscommunications and fundamental misunderstandings about both the system being studied and the mathematical tools being used. The author argues that until biomath becomes fully integrated into biology such miscommunications cannot be avoided and the field will not reach its full potential
Sustainability Perceptions of The Nappie Project
Get PDFDiaper need is a critical issue that often falls through the cracks of traditional assistance pathways. There are no state or federal programs that subsidize the cost of diapers. Some families must choose between food and diapers when finances fall short. This study employed a mixed methods approach and a cross-sectional design. Quantitative data was collected using the Program Sustainability Assessment Tool (PSAT), a 40-item multiple-choice survey instrument that assesses eight domains of sustainability. Nineteen individuals from The Nappie Project board, agency partners, community advisors, and volunteers received an email invitation to participate in the PSAT survey. The survey was analyzed as two separate groups, Current/Former Board Members and Community Partners/Advisors. Of the participants who completed the survey, two individuals participated in semi-structured interviews to provide further insight into the results of the survey. The lowest score for both groups was Funding Stability. The highest score for the Board was Environmental Support. The highest score for Community Partners was Communications. The greatest range for both groups was Strategic Planning. Three domains were found to be significantly different: Overall Sustainability, Partnerships, and Communications. All health care providers, especially those who engage with children, should be educated regarding diaper need. While policy was not addressed in this study, there is a great opportunity to advocate for diaper need among policymakers. Finally, sustainability is an increasingly important concept to many grant writers and funding agencies. This work may be applied to a variety of public health organizations to strengthen funding proposals
ASHP Foundation Pharmacy Forecast 2019: Strategic Planning Advice for Pharmacy Departments in Hospitals and Health SystemsForewordIntroduction: An Environmental Scan to Inform Strategic PlanningFuture of Pharmacy Education and WorkforceMedications Are Key Drivers of Healthcare Finance and Care DeliveryThe Opioid CrisisEthical Issues: Conflicting Imperatives and Erosion of Behavioral NormsTechnology Innovations and Involvement by Pharmacy LeadersEmpowering Patients to Optimize Medication UsePharmacists in Patient CareDisruptive Forces in Healthcare
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Medication use and indicators of poor asthma control in patients with and without allergies
No full textBackground: Approximately two-thirds of people with asthma have some evidence of allergy; their condition differs from nonallergic asthma in terms of predominant symptoms and clinical outcomes. Objective: To compare asthma control and medication use among patients with persistent asthma with evidence of allergy (PA-EA) and patients with persistent asthma with no evidence of allergy (PA-NEA). Methods: A retrospective analysis of survey responses and medication claims data from the Observational Study of Asthma Control and Outcomes study, a prospective survey linked to retrospective claims-based analysis of patients ages ≥ 12 years with persistent asthma in a U.S. health maintenance organization. Evidence of allergy was defined as both a positive response to a survey question about hay fever and/or seasonal allergies and one or more medical diagnostic codes for atopic conditions. Regression models were used to compare asthma control (Asthma Control Questionnaire [ACQ] scores) and asthma medication use between PA-EA and PA-NEA. Results: Adjusted data showed that, versus the patients with PA-NEA (n = 312), patients with PA-EA (n = 971) had higher (worse) 5-item and 6-item ACQ (ACQ-5 and ACQ-6) scores (by 0.34 [95% confidence interval {CI}, 0.24-0.44]; and 0.31 [95% CI, 0.21- 0.40], respectively), were more likely to have poorly controlled asthma (ACQ-5 score ≥ 1.5: Odds ratio 3.37 [95% CI, 2.07-5.50]; ACQ-6 score ≥ 1.5: Odds ratio 3.46 [95% CI, 2.13-5.62]) and less likely to have well-controlled asthma (ACQ-5 score ≤ 0.75: Odds ratio 0.21 [95% CI, 0.13- 0.34]; ACQ-6 score ≤ 0.75: Odds ratio 0.21 [95% CI, 0.13- 0.35]). Patients with PA-EA also had greater asthma medication use, most notably 2.5 times more prescriptions of high-dose inhaled corticosteroid in a 4-month period (95% CI, 1.21-5.16) and 16.15 times higher odds of chronic oral corticosteroid use (95% CI, 1.50 -174.09) versus PA-NEA. Conclusion: The patients with PA-EA versus PA-NEA had worse asthma control and greater medication use. These patients may need more vigilant clinical oversight and treatment management to ensure adequate asthma control
Short-term effects of manual therapy in patients after surgical fixation of ankle and/or hindfoot fracture: A randomized clinical trial
No full textU BACKGROUND: Patients with surgical fixation of ankle and/or hindfoot fractures often experience decreased range of motion and loss of function following surgery and postsurgical immobilization, yet there is minimal evidence to guide care for these patients. U OBJECTIVES: To assess whether manual therapy may provide short-term improvements in range of motion, muscle stiffness, gait, and balance in patients who undergo operative fixation of an ankle and/or hindfoot fracture. U METHODS: In this multisite, double-blind randomized clinical trial, 72 consecutive patients who underwent open reduction internal fixation of an ankle and/or hindfoot fracture and were receiving physical therapy treatment of exercise and gait training were randomized to receive either impairment-based manual therapy (manual therapy group) or a sham manual therapy treatment of light soft tissue mobilization and proximal tibiofibular joint mobilizations (control group). Participants in both groups received 3 treatment sessions over 7 to 10 days, and outcomes were assessed immediately post intervention. Outcomes included ankle joint range of motion, muscle stiffness, gait characteristics, and balance measures. Group-by-time effects were compared using linear mixed modeling. U RESULTS: There were no significant differences between the manual therapy and control groups for range of motion, gait, or balance outcomes. There was a significant difference from baseline to the final follow-up in resting gastrocnemius muscle stiffness between the manual therapy and control groups (–47.9 N/m; 95% confidence interval: –86.1, –9.8; P = .01). There was no change in muscle stiffness for the manual therapy group between baseline and final follow-up, whereas muscle stiffness increased in the control group by 6.4%. U CONCLUSION: A brief course of manual therapy consisting of 3 treatment sessions over 7 to 10 days did not lead to better short-term improvement than the application of sham manual therapy for most clinical outcomes in patients after ankle and/or hindfoot fracture who were already being treated with exercise and gait training. Our results, however, suggest that manual therapy might decrease aberrant resting muscle stiffness after ankle and/or hindfoot surgical fixation
Effectiveness of Physical Therapy Combined With Epidural Steroid Injection for Individuals With Lumbar Spinal Stenosis: A Randomized Parallel-Group Trial
No full textObjective: To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS). Design: Randomized clinical trial. Setting: Orthopedic spine clinics. Participants: A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54). Interventions: A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT). Main Outcome Measures: Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis. Results: No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P\u3c.001; 95% confidence interval [CI], −18.01 to −5.51) and 1 year (P=.01; 95% CI, −14.57 to −2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, −49.05 to −8.01), emotional well-being (P=.02; 95% CI, −19.52 to -2.99), and general health perception (P=.05; 95% CI, −17.20 to −.78). Conclusions: Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health